EDITORIAL: Inching closer to universality of health-care coverage

Chemotherapy drugs are administered to a patient at North Carolina Cancer. (GERRY BROOME / AP)

Universality of health-care coverage in Nova Scotia and, indeed, in Canada, has been more of a celebrated public value than an actual fact — particularly when we talk about access to and affordability of pharmaceuticals.

Nowhere has inequality of coverage been harsher than in chemotherapy. For some two decades, as cancer-killing drugs evolved from hospital-delivered infusions to capsule drugs taken at home, Nova Scotia cancer patients — along with those in the other Atlantic provinces and in Ontario — have had to live with a financial chemo lottery.

If your chemo was delivered intravenously in hospital, the cost was fully covered by the province. If your chemo was a pill, the high cost had to be borne by private or pharmacare insurance or out of your own pocket. If you had no insurance, your family income had to be extremely low, $15,700, for the province to offer special assistance.

The impact of this two-tier coverage went beyond a financial burden that could climb into tens of thousands of dollars a year. Working out how a patient would pay for oral chemos often delayed treatment and created a lot of additional anxiety. That’s why oncologists, cancer-care organizations and cancer patients’ survivors spent years pressing for an end to the chemo lottery.

In Nova Scotia, a program was finally launched this month that substantially reduces unequal coverage of oral and infused chemos, though not eliminating it entirely.

As announced in last fall’s budget, the province will now ensure that, retroactive to April 1, 2017, patients pay no more than four per cent of their net family income for oral chemo. And the cut-off for the low-income assistance program has been raised to $24,000. The coverage will cost $846,000 this fiscal year and $2 million is budgeted for each of the next three years.

This move to what is effectively coverage of catastrophic costs is a huge advance in Nova Scotia. But it’s still not equal coverage for all cancer patients and it doesn’t cover pain and anti-nausea meds. Some of the latter can be very expensive and can be key to maintaining a patient’s weight, which determines how much chemo he or she will receive. In this case, weight is life.

With more and more chemos being developed in capsule form, it’s also a welcome development that the federal government began moving in yesterday’s budget to finally create a national pharmacare plan.

The aim here, in respect to chemotherapy, should be to treat all patients and all cancers the same — to provide full coverage regardless of the method of delivery or whether it is in hospital or at home. Coverage should also acknowledge that chemotherapy involves more than the cost of chemo alone; it often involves other meds that allow the patient to tolerate the chemo and to maximize its benefit.

As announced in Federal Finance Minister Bill Morneau’s budget, former Ontario Health Minister Eric Hoskins will lead an advisory council on implementation of national pharmacare to recommend options for creating a plan. The Parliamentary Budget Office has placed the cost at $19 billion annually, considerably less than the $28.5 billion spent today by government and private insurance plans and by individuals out of pocket. The PBO reckons the plan’s buying power could trim $4 billion from drug costs. Mr. Hoskins has a vital mission ahead.